2023 CITI Application

Welcome to the DBT CITI 2023 Application.

If you are registering a DBT team of 2 or more, please instruct your team leader to fill out the DBT team section of the form below and submit your team application. If your team leader will not be present for CITI training, please designate one of your attending team members to act as team leader during the training.

If you are not currently a member of a DBT team please fill out the Individual Application section of the CITI Application.

Following completion of your team or individual application, your application will be reviewed and you will be notified if you have been accepted to participate in CITI 2023. Following acceptance to CITI 2023, team members will be sent a link for them to fill out their individual applications forms and an invoice will be sent.

CITI APPLICATION

Are you applying as an Individual Clinician or a DBT Team?
Please only fill out the individual application if you are applying as a solo clinician with no additional team members in attendance. If you are applying as a team (2 members or more) please have your DBT team leader submit one DBT Team application.
- Individual Clinician
- DBT Team
Individual Application
Select all that apply
- Private Practice
- Currently employed at an agency or facility that utilizes DBT treatment
- Currently employed at an agency or facility that does not currently utilize DBT treatment
- Current member of a DBT team
Name
First Last Licensure - Exactly as you would like it to appear on your completion certificate. E.g. Jane Doe, LCSW, CADC I
Year Graduated
Area of Study
Job Title
- Psychologist
- Social Worker
- Counselor
- Nurse
- Psychiatrist
- Occupational/Vocational Therapist
- Other
Other Job Title
Theoretical orientation(s) of your training
Phone
Email
May we add you to our email list?
Information will not be shared with third parties
- Yes, please
- No, thank you
Do you have any food sensitivities or allergies? If so, what are they?
Level of Participation
- DBT CITI Part I Only: For members of existing DBT programs who are not required to participate in CITI part II.
- DBT CITI Part I and II: For NEW DBT programs, and existing DBT teams, who wish to strengthen core competencies and refine program direction.
Do you want to attend day one-three in-person or virtual?
- In-person
- Virtual
Level of Participation
- DBT CITI Part I Only: For members of existing DBT programs who are not required to participate in CITI part II.
- DBT CITI Part I and II: For NEW DBT programs, and existing DBT teams, who wish to strengthen core competencies and refine program direction.
Previous DBT Training
- Read Dr. Linehan’s skills training manual (All participants must read before attending)
- Will read Dr. Linehan’s skills training manual before commencing the training (All participants must read before attending)
- Read Dr. Linehan’s articles/book chapters
- Read Dr. Linehan’s treatment manual (All participants must skim before attending)
- Attended a DBT study group at my current agency or past workplace
- Attended a 1/2 day DBT workshop
- Attended a full day DBT workshop
- Attended a 2 day DBT workshop
- Received DBT consultation(s)
- Conducted DBT interventions yourself
Please describe any DBT consultations you have received.
Please describe the DBT interventions that you have conducted yourself.
Please give a brief description of your experience learning and applying behavioral therapy.
Please give a brief description of your experience practicing mindfulness, mindfulness based practices, and/or delivering mindfulness based therapies
In your current or past clinical work, have you taught behavioral skills and/or psycho-educational materials to clients?
If yes, please give a clinical example.
Additional Comments
Scheduling
The intensive training lasts from 8:30 am to 5:00 pm each day and on some evenings there will be homework assignments. In addition, it will not be possible to answer pages or phone calls during the training or leave for other job responsibilities. Arrangements need to be made to meet these requirements. Will you arrange:
Coverage of outside responsibilities so you can come at 8:30 am, stay until 5:00 pm, and do up to 30 min of homework on some evenings?
- Yes
- No
Coverage for your work so you will not have to leave or take calls during the training?
- Yes
- No
CITI Planning and Development
People have a lot of reasons to learn DBT – from an inherent interest in the treatment, borderline personality disorder, or suicide to a desire to reduce burnout, meet expectations of supervisors, or try something new. The following questions are designed to help plan the training and will not be used as a basis for your team’s acceptance. There are no right or wrong answers!
What are your primary and personal goals for learning DBT?
What problems do foresee in participating in and completing DBT CITI?
What plans do you have to overcome the aforementioned problems? Please also indicate whether you have discussed these potential barriers with your team.
Additional Comments
DBT Team
Agency / DBT team name
Name of person submitting the CITI team application
First Last
Job Title
Email
Phone
CITI Team members
Number of CITI DBT team members.
DBT Team Leader
First Last
DBT Team Leader Phone
DBT Team Leader Email
Onsite DBT Team Leader
If your DBT team leader will not be onsite for DBT CITI, Please name a team member who will be onsite as DBT team leader.
First Last
Please list the first name, last name, and email address of each of your team members.
Please add additional team members using the plus sign to the right of the email address column. If you do not yet know the team members who will be participating, please enter "Unknown" under first name.
First name Last name Email address
Tell us about your team.
Do you want to attend day one-three in-person or virtual?
- In-person
- Virtual
Level of Participation
- DBT CITI Part I Only: For members of existing DBT programs who are not required to participate in CITI part II.
- DBT CITI Part I and II: For NEW DBT programs, and existing DBT teams, who wish to strengthen core competencies and refine program direction.
Please give a brief description of the treatments provided at your treatment facility (individual psychotherapy, case management, pharmacotherapy…)
List any specific team goals your team has for this training.
In a nutshell, describe your team and indicate your team’s goals with respect to building a DBT program.
Comments or questions
Tell us about yourself
Please give a brief description of the treatments you provide (individual psychotherapy, case management, pharmacotherapy…
List any specific goals you have for this training.
In a nutshell, describe yourelf and indicate your goals with respect to participating in DBT CITI.
Comments or questions
Invoicing
Name of the person responsible for processing invoices.
First Last
Email where invoice is to be sent.
Invoicing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Invoicing Phone

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2023 CITI Application

CITI APPLICATION

Individual Application

Scheduling

CITI Planning and Development

DBT Team

CITI Team members

Tell us about your team.

Tell us about yourself

Invoicing

DBT Training Calendar

News & Updates

Resources While You Wait

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